Complement inhibitors and B cell–modifying agents for IgA nephropathy—a Kidney Disease: Improving Global Outcomes (KDIGO) commentary

Kidney Disease: Improving Global Outcomes (KDIGO) updated its clinical practice guideline for the management of glomerular diseases in 2021, more than a decade after the first glomerular diseases guideline was published, reflecting slow progress in drug development. But since then, novel therapies for several glomerular diseases have been successfully tested and approved by regulatory agencies, none more so than IgA nephropathy (IgAN). To keep pace with new therapies, the IgAN guideline was updated again in 2025. After this revision came to press, 3 additional IgAN treatments received accelerated approval by the US Food and Drug Administration. Because the presumptive mechanisms of action of 2 of these new therapies are mechanistically different from those of previously approved drugs, the KDIGO IgAN Work Group felt that a brief commentary outlining where the new therapies may fit into the overall IgAN treatment strategy was warranted in lieu of a full guideline update, pending additional evidence for these and other therapies.